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Nutrition - patient-centredness

Challenges

The concept of person or patient-centredness is not new (Pelzang 2010). Implementation, however, is variable despite significant improvements in some areas and falls short of "active support for user engagement" (Picker Institute 2007, p.27). The challenge is to find relevant measures to capture experience and translate feedback into service improvement (King’s Fund 2011a).

User needs, service improvements

Despite this, advocate groups have articulated descriptions of services from a user perspective (Age UK 2010). Age UK has set out a seven step overview of what people should expect on admission to a hospital ward. Although written from the perspective of care of the elderly in an acute setting there is much that is transferable for other users and other care settings.

The first step is: "Hospital staff must listen to us, our relatives and our carers" and goes on to say: “We know what food we like or dislike, what food we can’t eat and whether we have small or large appetites. We need ward staff to ask us what our needs are at mealtimes and then act on what we say. If we, or our relatives and carers, are not consulted about our dietary needs we often end up with food that we simply cannot eat”.

Age UK then follow the step with an example of patient or carer feedback and an example of an initiative from a trust of what implementation looks like. In the case of the first step the action given is from Cambridge University Hospitals NHS Foundation Trust that has, supported by Age UK Cambridgeshire, developed pictorial menus to make it easier for people in later life to choose their meals.

The second step is: “All ward staff must become food-aware”. The statement expands on this, “Missing a meal is just as important as a missed medication. Ward staff need to understand that every meal is important and it is not acceptable for us to miss even one meal. If we do it increases our chances of becoming malnourished”. A case study highlights the 'Nutrition Mission', a nutrition training programme offered by Pennine Acute Hospitals Trust.

Tools and guides

Tools associated with implementing models of patient-centred care include observation of practice resources and methods for gathering patient/staff stories (RCN 2007). Developments in social media are producing innovative ways of providing feedback on services that could further support person/patient-centred care (Patient Opinion 2011). Practical guides to improving engagement and user experience are available (King’s Fund 2011b, Picker Institute 2009).

References

These resources were last accessed on 29 January 2013. Some of them are in PDF format - see how to access PDF files.

Age UK (2010) Still hungry to be heard (PDF 1.45MB). London: Age UK.

King’s Fund (2011a) The patient-centred care project (PDF 255KB). London: King's Fund.

King’s Fund (2011b) Experience-based co-design. King's Fund website.

Patient Opinion (2011) “Excellent ideas from Rotherham nutrition and dietetics team”. Patient Opinion website. 

Pelzang R (2010) Time to learn: understanding patient-centred care. British Journal of Nursing 19(4) Jul 22 pp.912-7. (This is available full text in the RCN e-library at e-journals).

Picker Institute (2007) Is the NHS becoming more patient-centred? (PDF 958KB). Oxford: Picker Institute Europe.

Picker Institute (2009) Using patient feedback: a practical toolkit. Oxford: Picker Institute Europe.  

Royal College of Nursing (2007) Workplace resources for practice development. London: RCN.

Further resources

See also core nutritional care resources.

Royal College of Nursing (2010) Principles of Nursing Practice: Principle D
The Principles describe what everyone can expect from nursing practice, whether colleagues, patients, their families or carers. Principle D encompasses themes of advocacy, empowerment, patient-centred care, and patient involvement in their care. This page brings together RCN resources which are particularly relevant to this Principle.